A 75-item schema questionnaire built for nursing homes
- A Groningen team gave the 205-item Young Schema Questionnaire (YSQ-L2) to 214 people aged 35 to 97, mean age 69, in Dutch nursing homes and outpatient geriatric and psychiatric services; mean MoCA was 23.0.
- Nine of the 205 items functioned differently in people with a MoCA below 24 and were excluded from item selection.
- The short form, YSQ-GeMS, keeps five items for each of 15 schemas, 75 items in all; 27 of them were chosen on face validity where discrimination was comparable. The Social Undesirability scale was dropped.
- The full questionnaire took about 75 minutes in this sample; with 63% fewer items, the authors expect the short form to take around 28 minutes. No cut-off scores are given.
Schema therapy has begun to reach older adults with personality disorders, and a randomised trial has already tested group schema therapy in this age group. A team from Groningen points to an earlier obstacle: before treatment comes the 205-item Young Schema Questionnaire, which took about 75 minutes to complete during their data collection.
Five items per schema
The Dutch YSQ-L2 went to 214 people aged 35 to 97 in nursing homes and outpatient services. Residents of somatic nursing-home units averaged 82 years. The mean MoCA of 23.0 sits in the range of mild impairment; dementia, delirium and severe active disorders were exclusion criteria. When the form was too tiring, a researcher read the items aloud.
Item response theory let the authors keep five items per schema, spread across levels of severity and chosen for discrimination. Where neighbouring items performed alike, three schema therapists picked by face validity – 27 of the final 75. Nine items behaved differently in people with a MoCA below 24, and none of them was eligible.
One scale dropped, one with a caveat
Social Undesirability did not survive: three of its nine items showed that bias and two discriminated poorly. Enmeshment kept its five items, but scores bunched at both ends of the range; the authors suggest that items about parents mean less to people whose parents have died. Across scales, the items were most sensitive at moderate to high schema activation.
Using it on the ward
My view is that in geriatric care the method was ready before the paperwork was. A resident who tires after twenty minutes will not get through 205 items, and the assessment then quietly stops. Use the short form before treatment and again to track change, reading each schema as its own scale. There are no cut-offs, so a high score is a hypothesis for the interview. Treat Enmeshment with caution. The item list in the supplement is Dutch.
In a nursing home schema therapy first runs into the length of the questionnaire, and a 75-item form brings the assessment within reach of a single visit.
The authors did not run a confirmatory factor analysis or compare the short form with external instruments, and agreement with the full form is shown in scatterplots. Diagnoses of personality disorder were not recorded, and age and education differed across the recruitment settings.